Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial

Sleep. 2015 May 1;38(5):735-44. doi: 10.5665/sleep.4666.


Study objectives: Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective.

Design: A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year.

Setting: U.S. healthcare system; third-party payer perspective.

Participants: 83% male cohort with mean age of 54.5 years.

Interventions: UAS vs. no treatment.

Measurements and results: UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY.

Conclusions: Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system.

Keywords: cost effectiveness; hypoglossal nerve; implantable neurostimulators; obstructive sleep apnea; upper airway stimulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis*
  • Female
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / epidemiology
  • Quality-Adjusted Life Years
  • Risk
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / economics*
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / therapy*
  • Stroke / complications
  • Stroke / epidemiology